Integrating Inter-Professional Insights for Enhanced Disaster Response: A Cross-Sectional Analysis in Jubail's Royal Commission Hospital, Saudi Arabia.

Introduction: This study aimed to evaluate disaster preparedness and management among an inter-professional team at the Royal Commission Hospital (RCH) in Jubail, Saudi Arabia. Methods: Conducted between May and July 2023, this cross-sectional study involved healthcare providers in both patient-facing and non-patient-facing roles. Participants responded to a comprehensive online questionnaire comprising 22 questions across seven sections covering aspects of emergency response, disaster management, and infection control. The study targeted a minimum sample size of 500 participants, successfully garnering responses from 512 individuals. Results: Of the 512 participants, 59.9% (n=312) were healthcare providers in patient-facing roles, and 40.1% (n=209) were in non-patient-facing roles. The results revealed notable disparities in awareness and preparedness between these two groups. Healthcare providers demonstrated higher awareness levels compared to their non-patient-facing counterparts. For instance, 76.9% of healthcare providers were aware of the hospital's emergency response plan compared to 56.2% of non-healthcare providers (χ² = 52.165, p < 0.001). Similar disparities were observed in understanding the term "disaster" (86.5% vs 54.1%, χ² = 27.931, p < 0.001), and awareness of a command center (73.4% vs 45.2%, χ² = 42.934, p < 0.001). Discussion: These findings underscore the critical need for enhancing awareness, education, and preparedness within healthcare facilities, emphasizing an integrated approach that includes both healthcare and non-healthcare staff. By addressing these gaps, healthcare facilities can significantly improve their emergency response efficiency, disaster management capabilities, and infection control measures, thereby enhancing the overall safety and quality of patient care.

Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs.

AIM: The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs. DESIGN: An ethnographic design using multiple convergent data collection techniques. METHODS: Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings. RESULTS: Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed 'safe care transition pathway' addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions. CONCLUSION: To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions. IMPLICATIONS: The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes. REPORTING METHOD: Findings are reported per the Consolidated Criteria for Reporting Qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A psychometric evaluation of inter-professional education competency tool in nursing and medicine students.

INTRODUCTION: Collaboration between nurses and doctors is necessary for offering care to patients. Using team performance assessment tools and surveying them can be effective in promoting inter-professional collaboration, and the lack of a credible tool to assess inter-professional collaboration competency between the two groups is a major challenge in the healthcare sector. The present study aimed to translate and conduct a psychometric investigation on the inter-professional education collaboration (IPEC) tool for the students of medicine and nursing. METHODS: The present study was a cross-sectional one conducted as a psychometric investigation of the IPEC tool at the Iran University of Medical Sciences in 2022. The initial tool contained 42 items developed according to a 5-point Likert scale, which was translated into Persian with the consent of the original researcher. The validity index and the content validity ratio were investigated by a panel of 11 specialists in medical and clinical education, and its construct validity was evaluated using confirmatory factor analysis. Also, the second population of the study included medical and nursing students of Iran University of Medical Sciences and simple random sampling method. Moreover, the reliability of the instrument was investigated using internal consistency, Cronbach's Alpha, and test-retest methods. RESULTS: Based on the indicators calculated to perform a psychometric investigation over the above tool, it had acceptable reliability and validity according to the specialists. The tool evaluates inter-professional collaboration competency between the students of medicine and nursing across four areas (values and ethics, roles and responsibilities, inter-professional communication, and team-based care and teamwork). Moreover, Cronbach's Alpha coefficient for the tool was determined at 0.84. CONCLUSION: The results of the study showed that the above tool could evaluate inter-professional competency as a valid and reliable questionnaire, and its results could be utilized in planning and education.

BARRIERS AND ENABLERS OF INTERPROFESSIONAL COLLABORATION (IPC) AMONG HEALTH WORKERS IN A NIGERIAN TEACHING HOSPITAL.

Introduction: Interprofessional collaboration is crucial to the optimal functioning of every health system because the complex nature of healthcare requires that health workers from different allied professions work as a team to deliver quality health to the patients. Identifying the enhancing factors and barriers to this synergy is essential to safe and efficient healthcare delivery. This study addresses this issue in Nigeria, where inter-professional rivalry is rife. Objective: To determine the enablers of, and barriers to, interprofessional collaboration in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. Methodology: The study adopted the proportionate stratified random sampling technique to recruit 266 staff of the hospital across the different health professions. Data was collected using an adapted version of the Assessment of Interprofessional Team Collaboration Scale (AITCS) and data analysis was done using the Statistical Package for Social Sciences version 23.0. The ideal scores pre-set were 4.0 for the enablers and 2.0 for the barriers. Ethical review for the study was obtained from the Ethics Review Committee of the hospital. Results: The mean score for the enablers was 4.28, and the strongest enabler of IPC identified was a climate of mutual respect, dignity, and trust among team members (4.36). On the other hand, the mean score for the barriers was 3.80, and the strongest barrier to IPC was the lack of role clarification (3.84). Conclusion: The study revealed a strong level of enablers to IPC in ATBUTH. However, the barriers were above the set threshold, suggesting a significant impediment to IPC. The hospital should strengthen the identified enablers while making efforts to reduce the barriers. This type of study is also recommended for other hospitals in the country.

The willingness and barriers to collaborate in the care of frail older adults: perspectives of primary care professionals.

BACKGROUND: This study investigated the perspectives of primary care professionals, in particular general practitioners, registered nurses, physiotherapists and occupational therapists, on inter-professional collaboration, the barriers and the facilitators they perceive in the care of the frail older population. METHODS: We conducted a qualitative study. In-depth interviews with healthcare professionals were performed, using open-ended questions about their perceptions on the care of frail older adults and inter-professional collaboration. Data was analyzed following the Basic Logical Model of Abduction and Creswell's coding method. RESULTS: Healthcare professionals indicated that when they explored problems complementary to the reasons for older people to contact a healthcare professional, these additional problems often seemed to be the main problem. They also stated that there was too little inter-professional collaboration in the care of complex chronic issues and lack of a shared vision on collaboration. Collaboration is still limited too much to contacting established professions. Health information technology can support both, inter-professional collaboration and working on an evidence-based manner. It can also be a facilitator to inform patients. The availability and use of health information technology differs between the professions. Success factors and barriers for sustainable collaboration were identified on several levels, namely innovation, individual, professional, patient, social context, context of the organization, economic and political context. CONCLUSIONS: Our study shed light on the willingness and barriers in collaboration of healthcare professionals in primary care for older adults. There is little inter-professional collaboration, despite the willingness of the healthcare professionals to collaborate.

Considerations for promoting the implementation of work-based interprofessional education programmes: A scoping review.

BACKGROUND: Effective inter-professional collaboration may improve healthcare outcomes, including maternal and child healthcare settings where unfavourable outcomes are often due to communication and collaboration failures. OBJECTIVE: Explore the considerations for promoting the implementation of work-based interprofessional education programmes. METHODS: A scoping review guided by the methodological framework of Arksery and O'Malley was used to analyse 28 articles published between 2000 and 2020. The reporting was guided by the PRISMA extension for Scoping Reviews. RESULTS: Twenty-seven of 28 articles were studies conducted in high-income countries. The review revealed considerations which were themed as 1) mobilisation of resources, 2) helpful learning environment, 3) healthcare professional's valuation and 4) barriers prior to implementing IPE/IPC. Successful implementation of interventions triggered motivation, confidence, self-efficacy, value for IPE/IPC. CONCLUSION: Our findings demonstrate that there are specific considerations that can contribute to the uptake of IPE/IPC interventions in the clinical setting.

Elder care: The need for interprofessional collaboration between Family Physicians, Clinical Pharmacists, and Physiotherapists in home-based primary care teams.

Background: Elderly patients with pain and falls are commonly seen in family practice. Aims: (1) Highlight the role of a physiotherapist in the primary care team; (2) Discuss the collaboration between a family physician clinical pharmacist dyad and the physiotherapist that emerged; and (3) Share practice tools that emerged from our teamwork. Settings and Design: Home Based Primary Care Practice (a core component of family practice). We have described our home based primary care practice model in earlier publications. Our model utilizes a team based approach to address the prevention of diseases, promotion of health, provision of care for acute and chronic conditions (especially concurrent multi morbidity), and delivery of rehabilitation services in the home setting. Methods and Materials: Selection of three cases from our daily practice. Reflective discussion and learning towards arriving at novel insights and improving our care model. Results: Case discussion from the perspectives of the family physician, clinical pharmacist, and physiotherapist reveal important insights on the roles, responsibilities, benefits and tensions. A process flow to facilitate team based care is also outlined along with a referral communication tool. Conclusion: For our population of the elderly with falls and pain, there was a need for a physiotherapist, as part of the team, instead of a mere referral service. This was felt because of the growing needs of patients, multiple gaps in communication with external referrals, mismatch of values and approaches, and missed opportunities for high quality care. This enhances access, optimizes clinical outcomes, delivers patient centred care, reduces unnecessary hospitalizations, and avoids catastrophic and unwarranted costs. The paper highlights the critical need for interprofessional collaboration between family physicians, clinical pharmacists and Physiotherapist in elder care.

Caring for the poor: Lessons learned from a simulation on social determinants of health.

Poverty is a dominant social determinant of health (SDOH). One in 10 people in the United States lives in poverty. During the pandemic unemployment increased exponentially, swelling the number of individuals and families with limited resources. Adverse health outcomes and challenges in accessing healthcare for the poor are well documented. This paper describes a simulation comprised of case study enactments to increase collaboration among future healthcare providers as they mitigate the negative impact of SDOH, with particular focus on poverty. University students from schools of nursing, public health, and medicine, joined by health care and social service providers from the community, engaged in problem solving through role playing enactments of case studies. Focus groups were conducted to explicate the process and capture challenges, triumphs, and problem solving strategies associated with SDOH, particularly poverty. Directed content analysis and thematic analysis were used to analyze the focus groups. Six themes emerged from simulation debriefings that provide critical lessons related to SDOH and caring for the poor: "When it Rains, it Pours," "Coming of Age Too Soon," Delay and Deny, "Time is Money," "When You Don't Know Your Options, You Don't Have Any," and "Walking in the Shoes of Others." Recommendations included using simulations, with focus groups as a primary methodological approach, for preparing and updating the skills of the present and future healthcare workforce in addressing SDOH especially as recovery from the pandemic takes place.

Reducing Changeover Time Between Surgeries Through Lean Thinking: An Action Research Project.

Background: Maximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries. Methods: Using an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite. Results: Improved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources. Conclusion: Lean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.

Together Yet Apart: Remedies for Tensions Between Volunteers and Health Care Professionals in Inter-professional Collaboration.

While volunteering is an essential factor in service delivery in many societal areas, the inclusion of volunteers in formal settings can also lead to tensions. In this article, we combine the literature on volunteering and inter-professional collaboration (IPC) to elaborate a framework regarding remedies for tensions between professional staff and volunteers within IPC in health care provision to ensure successful collaboration. Using a dyadic survey design to interview volunteers and volunteer managers, we show that the perspectives of volunteers and volunteer managers on the antecedents of effective IPC differ in paradoxical ways. While volunteer managers apply organizational logic concerning tasks and processes to avoid tensions, volunteers seek solutions on a relational basis. However, rather than trying to resolve these paradoxes, our study indicates that carefully managing tensions arising between volunteers and professional staff may be more successful than trying to resolve all tensions.

Systemic support for learners with developmental language disorders in Zimbabwe and South Africa.

BACKGROUND: Teachers play a significant role as early identifiers of learners with developmental language disorder (DLD). They provide important information to other professionals for further specialist support of such learners. Professionals, such as educational psychologists, speech-language therapists (SLTs) and learning support therapists are involved in assisting learners with DLD; hence, inter-professional collaboration (IPC) amongst these professionals is of paramount importance in meeting the needs of learners. OBJECTIVES: This study aimed to examine systemic support strategies available to learners with DLD. METHOD: This was a multiple case study of Zimbabwe and South Africa. Purposive sampling was used to select participants. The study consisted of 56 participants: 5 teachers, 2 SLTs, a learning support therapist, an educational psychologist and 47 learners. A qualitative research approach was employed and data were collected using interviews, focus group discussions and classroom observations. The data were analysed thematically and categorised. RESULTS: Support strategies employed by teachers include remedial lessons and promoting a culture of reading for leisure to enhance learners' vocabulary and narrative skills. The SLTs and the learning support therapist use speech-language programmes and assistive technologies. Limited IPC and the absence of SLTs in District Based Support Teams were some of the challenges identified. The results also indicate that SLTs receive referrals mostly from primary schools compared with secondary schools. CONCLUSION: Raising awareness of DLD in schools and communities is deemed essential. Inter-professional collaboration is recommended to support learners with DLD as it increases the exchange of ideas and mutual acknowledgement of expertise amongst professionals.

Inter-Professional Collaboration and Occupational Well-Being of Physicians Who Work in Adverse Working Conditions.

Inter-professional collaboration, empathy and lifelong learning, components of medical professionalism, have been associated with occupational well-being in physicians. However, it is not clear whether this role persists in adverse working conditions. This study was performed to assess whether this is the case. These three abilities, and the self-perception of somatization, exhaustion and work alienation, were measured in a sample of 60 physicians working in a hospital declared to be in an institutional emergency. A multiple regression model explained 40% of the variability of exhaustion, with a large effect size (Cohen's-f2 = 0.64), based on a linear relationship with teamwork (p = 0.01), and more dedication to academic (p < 0.001) and management activities (p < 0.003). Neither somatization nor alienation were predicted by empathy or lifelong learning abilities. Somatization, exhaustion, or alienation scores either explained empathy, inter-professional collaboration or lifelong learning scores. These findings indicate that, in adverse working environments, physicians with a greater sense of inter-professional collaboration or performing multi-task activities are more exposed to suffering exhaustion.

[Gaining consensus on key terms in community health activities: A national survey using the Delphi method].

Objectives　The purpose of this study was to define the terminology used in community health activities by systematically establishing agreement among public health nurses and related professionals, to aid them in effectively cooperating with other professionals.Methods　We extracted the major terms described in "Guidelines for Public Health Nurses' Activities in the Region," which was issued by the Director of Health Bureau, Ministry of Health, Labor and Welfare; and conducted 2 iterations on the proposed definition of the terms using the Delphi method. The survey targeted 800 stakeholders from the following 4 professions: public health nurses in managerial positions in local governments, clerical staff in local governments, public health nursing professors at educational institutions, and social welfare council staff. Respondents indicated their degree of agreement with the definition of the terms using a 4-point Likert scale. We tallied the answers indicating "I agree" or "Mostly agree." A 70% term agreement was considered "conformed." A free text box for each proposed definition was also available so that respondents could share their opinions and offer alternatives.Results　The first survey received 231 responses. The conformity of their definitions ranged from 83.9%-96.9% (mean=91.5%). Although all definitions exceeded the consensus level, we examined their adequacy with reference to the definitions and opinions from the free text. Various opinions were obtained from those engaged in each occupation. The second round included 117 consenting stakeholders from the first survey, yielding 90 responses. Their degree of conformity ranged from 86.7%-98.9% (mean=94.6%). Therefore, we determined the definitions had reached a robust agreement. We revised the definitions of some terms with reference to the opinions from the free texts and finalized the definitions. Finally, we defined 23 terms-such as region, community diagnosis, and policy.Conclusion　All terms had a conformity of more than 85%, thus bringing into alignment those community health terms that had varying interpretations among related occupations earlier. By including the opinions of those from the related occupations who collaborate with public health nurses, the definitions of these terms could be established and shared. These definitions can be used in public health nursing practice, education, service, and research-among those in involved these related occupations.

Doctors', nurses' and clinical associates' understanding of emergency care practitioners.

BACKGROUND: Healthcare professionals' understanding of the knowledge, skills and training of their counterparts from other disciplines cultivates appreciation and respect within the workplace. This, in turn, results in better teamwork and improved patient care. Emergency departments are places where emergency care practitioners (ECPs) engage with doctors, nurses and clinical associates. Whilst the importance of inter-professional communication and teamwork between in-hospital professionals and pre-hospital emergency care providers is acknowledged, no literature could be found describing exactly how much these in-hospital professionals understand about the training and capabilities of their ECP colleagues. AIM: The aim of this study was to assess the level of understanding that prospective doctors, nurses and clinical associates have regarding the training and capabilities of ECPs. SETTING: The research was conducted in Johannesburg, South Africa, at two universities. METHODS: Seventy-seven participants completed a purpose-designed questionnaire assessing their understanding regarding the education and clinical capabilities of ECPs. RESULTS: In total, 64% of participants demonstrated a poor understanding of the level of education and clinical capabilities of ECPs. The remaining 36% showed only moderate levels of understanding. CONCLUSION: Medical, nursing and clinical associate graduates have a generally poor understanding of the education and clinical capabilities of their ECP colleagues who practise predominantly in the pre-hospital environment. This lack of understanding can become a barrier to effective communication between ECPs and in-hospital staff during patient handover in emergency departments. CONTRIBUTION: This research highlights a lack of understanding about the role and function of South African ECPs as pre-hospital emergency care providers and the need for more effective inter-professional education.

Supporting the end of prostitution permanently (SEPP) prostitution court: examining inter-professional collaboration within alternative criminal justice settings.

Problem-solving courts such as prostitution courts are becoming an important feature of the American court landscape. Internationally, while there is a great deal of skepticism regarding problem solving courts, at least five countries (e.g., England, Scotland, Ireland, Australia, and Canada) are deliberating whether this "revolutionary panacea" which has swept America's criminal justice system is the right approach for them. Few studies have explored the benefits and challenges of problem solving courts (i.e. prostitution court) using an interprofessional collaborative framework. The purpose of this case study is to examine contemporary issues related to prostitution courts using Bronstein's model of interprofessional collaborative framework which identifies five components that facilitate optimum IPC: 1) interdependence, 2)newly created professional activities, 3)flexibility, 4)collective ownership of goals, and 5) reflection on the process. Some benefits of IPC include working collaboratively, adaptability, adjusting expectations, investment in the process and making changes as needed. Some of the challenges of IPC were coercive power, dual roles, bait and switch, hierarchy, and push for outcomes at the expense of clients. As criminal justice systems nationally and internationally contemplate widespread implementation of different kinds of problem-solving courts, these benefits and challenges need to be considered before states and countries adopt these courts.

Establishing premises for inter-professional collaborative practice in school: inclusion, difference and influence.

PURPOSE: To ascertain stakeholders' agreement and disagreement about inter-professional collaboration (IPC) when supporting the child with a developmental language disorder (DLD) in school. MATERIALS AND METHODS: Two rounds of an online Delphi survey were undertaken with a purposive sample of 26 participants (researchers, practitioners and parents). Topics were informed by the views of children engaged in an earlier phase of the research. Agreement was set at an inter-quartile range of 1, with level of agreement measured using a five-point semantic differential scale. Qualitative data were examined using content analysis. RESULTS: There was strong agreement across the stakeholder groups about the child-led goals of IPC. Stakeholders also agreed that DLD is best viewed as a learning difference rather than a disorder. We identified ambivalence across the groups about the right of the child with DLD to have influence in decision-making about supports in school. CONCLUSIONS: We propose that IPC should be viewed as a means of ensuring the inclusion of the child in school. A shift in focus from remediating perceived deficits of the child, to affecting change in classroom practice, is also indicated. The need to reinforce the unconditional right of the child to have influence in decisions about supports is highlighted. Implications for IPC when meeting the needs of children with a developmental disability in school are outlined.IMPLICATIONS FOR REHABILITATIONThe goal of inter-professional collaboration should be to ensure the inclusion of the child with a developmental disability in school.Interventions delivered in school should focus on changing practice in the classroom, rather than on the child's perceived deficits.The child with a developmental disability should be given influence in collaborative decision-making to ensure supports are relevant and responsive to their needs.

Psychologist and Physician Inter-Professional Collaborative Experiences in Primary Care Integration.

In recent years, the subject of integrated healthcare, including the integration of behavioral health services into primary care, within the healthcare field has been increasingly of interest to researchers, providers, and policy makers. However, little is known about the experiences of providers within integrated care and the impact of these experiences on inter-professional relationships and collaboration. The researchers aimed to explore differences in providers' perspectives, including inter-professional collaboration and overall job satisfaction, by provider type and level of integration. The current study uses a mixed method exploratory approach, gathering both qualitative and quantitative data to investigate the perspectives of providers (both psychologists and physicians) on their work together. This study included 30 psychologists and 30 primary care physicians from three levels of healthcare integration (traditional/coordinated, co-located, and integrated). As hypothesized, results indicated that providers in integrated settings were the most satisfied with their collaboration with other providers. Furthermore, the providers' narratives revealed promising insights which contribute to a broader understanding of how to improve the relationships between psychologists and primary care physicians in integrated healthcare and other settings.

Healthcare professionals' experiences of inter-professional collaboration during patient's transfers between care settings in palliative care: A focus group study.

BACKGROUND: Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. AIM: To explore healthcare professionals' experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. DESIGN: Qualitative design, including focus group discussions. SETTING/PARTICIPANTS: The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital's palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals (n = 53) from different care settings. RESULTS: Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement.A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. CONCLUSION: From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.

Sexual Health Promotion among Swedish Adolescents - Professionals' Experiences.

In this grounded theory study the aim was to explore professionals' experiences of promotion of adolescents' sexual health, and views on inter-professional collaboration in relation to this subject. Data collection was by five focus group interviews and two pair interviews with professionals working with sexual health promotion in health care and schools. The results showed that professionals were reaching out to young people through competence and trusting relationships along with working on a broader front. In conclusion, professionals need to be knowledgeable about the world of young people, accessible and able to offer adequate support, and improve their inter-professional collaborations.

How ICU Patient Severity Affects Communicative Interactions Between Healthcare Professionals: A Study Utilizing Wearable Sociometric Badges.

Numerous factors affecting the interactions between healthcare professionals in the workplace demand a comprehensive understanding if the quality of patient healthcare is to be improved. Our previous cross-sectional analysis showed that patient severity scores [i.e., Acute Physiology and Chronic Health Evaluation (APACHE) II] in the 24 h following admission positively correlated with the length of the face-to-face interactions among ICU healthcare professionals. The present study aims to address how the relationships between patient severity and interaction lengths can change over a period of time during both admission and treatment in the ICU. We retrospectively analyzed data prospectively collected between 19 February to 17 March 2016 from an open ICU in a University Hospital in Japan. We used wearable sensors to collect a spatiotemporal distribution dataset documenting the face-to-face interactions between ICU healthcare professionals, which involved 76 ICU staff members, each of whom worked for 160 h, on average, during the 4-week period of data collection. We studied the longitudinal relationships among these interactions, which occurred at the patient bedside, vis-à-vis the severity of the patient's condition [i.e., the Sequential Organ Failure Assessment (SOFA) score] assessed every 24 h. On Day 1, during which a total of 117 patients stayed in the ICU, we found statistically significant positive associations between the interaction lengths and their SOFA scores, as shown by the Spearman's correlation coefficient value (R) of 0.447 (p < 0.01). During the course of our observation from Day 1 to Day 10, the number of patients (N) who stayed in the ICU gradually decreased (N = 117, Day1; N = 10, Day 10), as they either were discharged or died. The statistically significant positive associations of the interaction lengths with the SOFA scores disappeared from Days 2 to 6, but re-emerged on Day 7 (R = 0.620, p < 0.05) and Day 8 (R = 0.625, p < 0.05), then disappearing again on Days 9 and 10. Whereas all 6 SOFA sub-scores correlated well with the interaction lengths on Day 1, only a few of the sub-scores (coagulation, cardiovascular, and central nervous system scores) did so; specifically, those on Days 7 and 8. The results suggest that patient severity may play an important role in affecting the interactions between ICU healthcare professionals in a time-related manner on ICU Day 1 and on Days 7/8.